title: Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function.
abstract: BACKGROUND
  We hypothesized that simultaneous right and left ventricular apical pacing would result in improvement in left ventricular function due to improved coordination of segmental ventricular contraction. Structural changes in ventricular muscle present in dilated cardiomyopathy compromise ventricular excitation and mechanical contraction.
  
  
  RESULTS
  Eleven patients with depressed left ventricular function having cardiac surgery underwent epicardial multisite pacing with continuous transesophageal echocardiographic imaging. Quantitative measurement of percent fractional area change was performed, and segmental changes in contraction sequence resulting from simultaneous right and left ventricular pacing were assessed by application of phase analysis to recorded transesophageal images. There was no statistically significant difference between the paced QRS duration achieved with simultaneous right and left ventricular apical pacing and the native QRS duration (139+/-39 msec vs 106+/-18 msec, P = NS), but all other paced modes resulted in longer QRS durations. Percent fractional area change improved with simultaneous right and left ventricular apical pacing but not with other paced modes (41.5+/-11.9 vs 34.3+/-9.7, P < 0.01). Phase analysis demonstrated a resequencing of segmental left ventricular activation/contraction when compared to baseline ventricular activation.
  
  
  CONCLUSIONS
  Simultaneous right and left ventricular apical pacing results in acute improvements in global ventricular performance in patients with depressed ventricular function. Improvements may result from pacing-induced global coordination through recruitment of left and right ventricular apical and septal segments critical to effective ventricular contraction.
authors.affiliation: Department of Medicine, University of California, San Francisco 94143-1354, USA. saxon@ep4.ucsf.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Saxon
authors.forename: W F
authors.initials: WF
authors.lastname: Kerwin
authors.forename: M K
authors.initials: MK
authors.lastname: Cahalan
authors.forename: J M
authors.initials: JM
authors.lastname: Kalman
authors.forename: J E
authors.initials: JE
authors.lastname: Olgin
authors.forename: E
authors.initials: E
authors.lastname: Foster
authors.forename: N B
authors.initials: NB
authors.lastname: Schiller
authors.forename: J S
authors.initials: JS
authors.lastname: Shinbane
authors.forename: M D
authors.initials: MD
authors.lastname: Lesh
authors.forename: S H
authors.initials: SH
authors.lastname: Merrick
mesh_terms: D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D004562:Electrocardiography; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D010496:Pericardium / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*